Protocols for Uncontrolled Donation After Circulatory Death: A Comprehensive Approach to Refractory Cardiac Arrest

Ortega-Deballon, Iván; Plaza-Horche, Edurne De la

doi:10.1111/acem.12383

Cited by 4 publications

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“…The availability of these interventions poses potential conflicts of interest between lifesaving and organ-preserving strategies [ 41 , 42 , 46 ]. Some of us [ 7 , 51 , 64 , 65 ], and many other authors [ 38 – 42 , 46 , 48 , 49 , 53 , 66 ], have suggested different approaches, seeking to save lives, when still feasible, but providing also the option of organ donation when all lifesaving clinical efforts have been exhausted. Thus, a joint venture between clinical and research communities in transplantation and resuscitation should combine both strategies in order to improve resuscitation outcomes while expanding uDCD.…”

Section: Discussionmentioning

confidence: 99%

Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes

2015

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IntroductionA chronic shortage of organs remains the main factor limiting organ transplantation. Many countries have explored the option of uncontrolled donation after circulatory death (uDCD) in order to expand the donor pool. Little is known regarding the variability of practices and outcomes between existing protocols. This systematic review addresses this knowledge gap informing policy makers, researchers, and clinicians for future protocol implementation.MethodsWe searched MEDLINE, EMBASE, and Google Scholar electronic databases from 2005 to March 2015 as well as the reference lists of selected studies, abstracts, unpublished reports, personal libraries, professional organization reports, and government agency statements on uDCD. We contacted leading authors and organizations to request their protocols and guidelines. Two reviewers extracted main variables. In studies reporting transplant outcomes, we added type, quantity, quality of organs procured, and complications reported. Internal validity and the quality of the studies reporting outcomes were assessed, as were the methodological rigour and transparency in which a guideline was developed. The review was included in the international prospective register of systematic reviews (Prospero, CRD42014015258).ResultsSix guidelines and 18 outcome studies were analysed. The six guidelines are based on limited evidence and major differences exist between them at each step of the uDCD process. The outcome studies report good results for kidney, liver, and lung transplantation with high discard rates for livers.ConclusionsDespite procedural, medical, economic, legal, and ethical challenges, the uDCD strategy is a viable option for increasing the organ donation pool. Variations in practice and heterogeneity of outcomes preclude a meta-analysis and prevented the linking of outcomes to specific uDCD protocols. Further standardization of protocols and outcomes is required, as is further research into the role of extracorporeal resuscitation and other novel therapies for treatment of some refractory cardiac arrest. It is essential to ensure the maintenance of trust in uDCD programs by health professionals and the public.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0985-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes

2015

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“…Is there any fairer possible use of the means we have? By trying to save hopeless patients' lives, and when this is not possible, by increasing availability of organs for transplant, we will be providing near to excellent care to patients suffering refractory cardiac arrest in the field, and saving more lives one way or the other: Throughout high-quality resuscitation, and when really impossible despite of doing our best, throughout donation and transplantation after declaring death [25].…”

Section: Donation After Circulatory Determination Of Death From the Pmentioning

confidence: 99%

Cardiac Arrest, Resuscitation and Organ Donation: Joint Venture for Saving Lives One Way or Another. An Innovative and Ethically Sound Trail for Out-of- Hospital Cardiac Arrest

Ortega-Deballon¹

2015

J Clin Trials

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Determination of death, the exact moment that a person's death occurs, has been a constant challenge throughout human being history. What we already know is that death usually does not occur abruptly, at a specific time and for all parts of the body simultaneously. Human resistance to degradation by lack of oxygen varies depending on the type of cell and organ. It is possible, for example, for successful cornea transplants from deceased individuals as many as seven days after death. Actually, the absolute absence of any residual vital activity in the body after cessation of circulatory function, can only be confirmed once the putrefaction process is fully established and completely widespread throughout the corpse. It is not feasible logically, however, to wait until that point to declare death, due to safety and public health reasons.

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“…Is there any fairer possible use of the means we have? By trying to save hopeless patients' lives, and when this is not possible, by increasing availability of organs for ISSN: 2474-3674 transplant, we will be providing near to excellent care to patients suffering refractory cardiac arrest in the field, and saving more lives one way or the other: Throughout high-quality resuscitation, and when really impossible despite of doing our best, throughout donation and transplantation after declaring death [25].…”

Section: Donation After Circulatory Determination Of Death From the P...mentioning

confidence: 99%

Protocols for Uncontrolled Donation after Circulatory Death: International & Comprehensive Analysis

Ortega-Deballon¹

2015

Int J Crit Care Emerg Med

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Protocols for Uncontrolled Donation After Circulatory Death: A Comprehensive Approach to Refractory Cardiac Arrest

Cited by 4 publications

References 9 publications

Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes

Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes

Cardiac Arrest, Resuscitation and Organ Donation: Joint Venture for Saving Lives One Way or Another. An Innovative and Ethically Sound Trail for Out-of- Hospital Cardiac Arrest

Protocols for Uncontrolled Donation after Circulatory Death: International & Comprehensive Analysis

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